Alex M. Glazer

Analysis of Trends in US Melanoma Incidence and Mortality

Analysis of Trends in US Melanoma Incidence and Mortality The incidence of and mortality from invasive melanoma in the United States has risen steadily for at least the past 2 decades.1 Similar trends are being seen worldwide despite numerous efforts to enhance primary prevention and early detection, and these increasing rates are having an impact on the public health and economic burden of disease. In 2009, we reported on the status of US melanoma incidence at that time.2 The purpose of this study was to provide updated information on trends in melanoma incidence and mortality that will help to elucidate the current state of this cancer in the United States.

Frequency of total body skin examinations among US dermatologists

diagnosis made at the in-person visit by a dermatologist. Diagnostic performance was analyzed in terms of sensitivity, specificity, false-positive rate, and falsenegative rate for the decision regarding the referral of patients to an in-person consultation at the skin cancer unit. The diagnostic confidence level (DCL; 1, uncertain diagnosis; 2, likely diagnosis; 3, confident diagnosis), the nonreferral rate, the time spent by the GP and the remote dermatologist, and the image qualitywere also assessed in each study group. The most common lesion examined by teledermatology was seborrheic keratosis (29.2%, n 1⁄4 73), followed by common acquired melanocytic nevus (26.8%, n 1⁄4 67). Basal cell carcinoma was the most common malignant lesion diagnosed (6.4%, n1⁄4 16), followed by squamous cell carcinoma (4%, n 1⁄4 10). Thus, 10.4% (n 1⁄4 26) of patients were referred because of malignant lesions. In the overall series, 60.8% and 76.8% of the CTC and CTC1DTC groups, respectively, were not referred to the skin cancer clinic (P 1⁄4 .001). The subanalysis of patients having pigmented lesions increased this nonreferral percentage to 69.39% and 89.13%, respectively (P 1⁄4 .001). The average time spent by the operating GPs was 7.44 minutes for CTC patients and 8.7 minutes for CTC1DTC patients (P 1⁄4 .01). The time spent by the dermatologist in the evaluation of CTC or CTC1DTC patients was 1.04 minutes and 1.22 minutes, respectively (P1⁄4 .14). The percentage of cases with the highest DCL (DCL1⁄43) was 61.6% in the CTC group and 79.2% in the CTC1DTC group (P 1⁄4 .001). The frequency of low-quality pictures was 3.2% and 1.6% in the CTC and CTC-DTC groups, respectively (P 1⁄4 .41). The results of the diagnostic performance study are listed in Table I. The interim results of this prospective randomized and blinded study provide meaningful favorable data ahead of the definitive results of a large-scale study on the effect of the addition of dermoscopic images to the routine internet-based skin cancer triage.

Analysis of US dermatology physician assistant density

8 502 Des Moines, IA 10 4.7 9 253 Charleston, WV 5 4.3 10 998 Juneau, AK 2 4.0 11 915 Burbank, CA 4 3.7 12 571 Sioux Falls, SD 6 3.7 13 271 Winston Salem, NC 9 3.6 14 685 Lincoln, NE 9 3.4 15 288 Asheville, NC 4 3.3 16 235 Norfolk, VA 8 3.3 17 734 Ardmore, OK 3 3.2 18 844 Ogden, UT 6 3.2 19 534 Racine, WI 4 3.1 20 837 Boise, ID 8 3.1 21 591 Billings, MT 4 3.1 22 897 Carson City, NV 2 3.0 23 260 Wheeling, WV 4 3.0 24 181 Allentown, PA 5 3.0 25 268 Petersburg, WV 1 3.0

Dermatologists’ Perceptions, Recommendations, and Use of Sunscreen

Author Contributions: Ms Shah had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Shah, Mlacker, Aldahan, Carcioppolo, Bray, Nouri. Acquisition, analysis, or interpretation of data: Shah, Jacobsen, Aldahan, Carcioppolo, Nouri. Drafting of the manuscript: Shah, Jacobsen, Mlacker, Aldahan, Nouri. Critical revision of the manuscript for important intellectual content: Shah, Aldahan, Carcioppolo, Bray, Nouri. Statistical analysis: Shah, Jacobsen, Carcioppolo. Administrative, technical, or material support: Shah, Mlacker, Aldahan, Bray, Nouri. Study supervision: Carcioppolo.

Analysis of Trends in Geographic Distribution of US Dermatology Workforce Density

Analysis of Trends in Geographic Distribution of US Dermatology Workforce Density The demand for dermatologic care is rising. Dermatologist density in the Unites States has increased over the past decade and is currently estimated at 3.4 per 100 000 individuals.1 However, it is still below the suggested 4 per 100 000 population needed to adequately care for a community.1 Increased dermatologist density has been associated with lower melanoma mortality rates and improved diagnosis of skin disease.2 Therefore, dermatologist density is of critical importance and may lead to lower skin disease economic burden. In addition to the undersupply, there is also a material geographic variance of dermatologists throughout the United States leaving some areas underserved.1 Dermatologists are now being supplemented by nonphysician clinicians which may help to correct for the dermatology provider shortage. The purpose of this study was to examine the combined geographic distribution of dermatologists and dermatology physician assistants (DPAs) to determine overall dermatology provider density and how this combination may potentially be augmenting access.

Noninvasive Technologies for the Diagnosis of Cutaneous Melanoma

Multispectral analysis devices assess pigmented lesion disorganization at different levels using variable wavelengths of light. Computerized algorithms measure morphologic disorganization of the pigmented skin lesion. Aggregated data of 855 participants investigating the influence of multispectral digital skin lesion analysis (MSDSLA) on practitioner decisions to biopsy pigmented skin lesions revealed the overall sensitivity for detection of melanoma improved from 70% to 88%. Participant specificity increased from 52% to 58% after MSDSLA. Five studies using spectrophotometric intracutaneous analysis scope to evaluate suspicious pigmented skin lesions demonstrated an overall sensitivity and specificity of 85% and 81%, respectively, for the detection of melanoma.

Trends in US sunscreen formulations: Impact of increasing spray usage

Among the 3 central dermatopathologists All diagnosesy 0.91 0.86-0.95 92 KC 0.91 0.83-0.97 95 BCC 0.96 0.92-0.99 97 BCC, aggressivez 0.57 0.45-0.70 83 BCC, all subtypes 0.78 0.72-0.84 80 SCC 0.90 0.82-0.96 95 SCC, invasive 0.79 0.67-0.88 92 SCC, in situ 0.52 0.29-0.72 92 AK 0.77 0.63-0.90 94 Between local pathologists and central dermatopathologists All diagnosesx 0.83 0.76-0.90 90 KC 0.78 0.66-0.90 93 BCC 0.93 0.87-0.99 97 SCC 0.83 0.73-0.93 94 SCC, invasive 0.82 0.70-0.94 95 SCC, in situ 0.48 0.20-0.75 94 AK 0.56 0.34-0.78 93 Between dermatopathologist 1 and local pathologists All diagnosesk 0.79 0.77-0.82 86 KC 0.83 0.80-0.87 93 BCC 0.92 0.90-0.95 96 SCC 0.78 0.73-0.83 94 SCC, invasive 0.75 0.68-0.81 95 AK 0.59 0.52-0.66 91 Intrarater (test-retest) reliability of dermatopathologist 1 All diagnoses{ 0.83 0.76-0.90 89 KC 0.91 0.83-0.98 96 BCC 0.92 0.86-0.98 96 SCC 0.92 0.84-1.0 97 AK 0.56 0.36-0.77 91

Integrating Skin Cancer–Related Technologies into Clinical Practice

Early diagnosis and treatment of melanoma improve survival. New technologies are emerging that may augment the diagnosis, assessment, and management of melanoma but penetrance into everyday practice is low. In the current health care climate, greater emphasis will be placed on the incorporation of technology for clinically suspicious pigmented lesions to facilitate better, more cost-effective management.